Why Has Childhood Bipolar Disorder Become an Epidemic?

When a young child’s behavior problems go beyond mere toddler tantrums, parents face bleak choices about how to treat them. Should they seek psychiatric or psychological help? Should the child be put on medication or some other behavioral treatment? Should he or she be labeled with a psychiatric illness like bipolar disorder?

Slate had a compelling look at the question this week, which, unlike many previous articles on the topic, does not reduce parents who seek treatment to gullible victims of fad diagnoses who simply want to drug away any sign of individuality in their children. (More on Time.com: Special — Kids and Mental Health).

Writer Darshak Sanghavi notes that the diagnosis of pediatric bipolar disorder emerged about a decade ago and has since been given a nod of acceptance by the mainstream medical establishment. Sanghavi writes:

All this has led to even more diagnoses, a putative epidemic of bipolar among the nation’s children, and a corresponding increase in the pediatric use of antipsychotics, mood stabilizers, and other drugs often used to treat bipolar adults. More than 8,000 children in Massachusetts are prescribed antipsychotic medications like Zyprexa, for example… That’s worrisome since, according to a British government review, the evidence behind drug treatment for the condition in kids is “extremely limited,” and several drugs cause major weight gain (roughly 20 pounds in two months on average), hormone problems, and other side effects.

But criticizing widespread proliferation and drug treatment of pediatric bipolar disorder misses the important underlying problem. Normal families don’t seek out stigmatizing labels and give their kids scary drugs for the hell of it. They do these things because they are at wit’s end.

Unfortunately, drug companies looking to increase sales have used parents’ desperation very much to their advantage, and their strategy has been especially successful given the backdrop of a fragmented health system with a chronic shortage of child psychiatrists and little insurance coverage for psychological or behavioral therapies that don’t carry the risk that medications do. (More on TIME.com:Mind Reading: Carl Elliott on the Dark Side of Medicine).

Bioethicist Carl Elliott recently also told me that the rise in bipolar diagnoses has contributed to a huge spike in the sales of antipsychotic medications. “Bipolar is the big one here,” he said. “Now, everybody’s got it. It used to be rare, but you can chart the rise, and it goes up with the introduction of ‘atypical’ antipsychotics.”

Now, more than 500,000 children take antipsychotic drugs. And the biggest fines in U.S. history — to the tune of several billion dollars — have been paid by pharmaceutical companies over the last few years for marketing these medications without FDA approval to treat children and the elderly. There still is no conclusive data about their long-term effectiveness or safety. Our kids deserve better!